Active NPI
Eduardo Diaz, D.D.S
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1922157288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 44306
- Practice address
- 3638 El Cajon Blvd
San Diego, CA 92104-1500 - Phone
- (619) 220-0548
- Fax
- (619) 220-8604
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 44306 | CA | Primary |
Addresses
Primary practice location
3638 El Cajon Blvd
San Diego, CA 92104-1500
Mailing address
3638 El Cajon Blvd
San Diego, CA 92104-1500
Phone (619) 220-0548
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598990319 | Other | CA | DENTICAL NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44306 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eduardo Diaz Dental Corporation | Current | Accepting new patients | |
| Eduardo Diaz DDS PC | Past | Accepting new patients | |
| North Park Smiles | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Chula Vista, CA
- NPI 1821223934
-
- Clinic/Center
- San Diego, CA
- NPI 1598990319
-
- Public Health Dentistry
- San Diego, CA
- NPI 1538358643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605312000000",
"number": "1922157288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3638 EL CAJON BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921041500",
"telephone_number": "619-220-0548",
"fax_number": "619-220-8604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3638 EL CAJON BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921041500",
"telephone_number": "619-220-0548",
"fax_number": "619-220-8604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "EDUARDO",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2020-11-14",
"certification_date": "2020-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "44306",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL NPI",
"identifier": "1598990319",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.